Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy

ABSTRACT Background Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. Methods This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. Results None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. Conclusion The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.

Electric hand warmer versus observation to avoid discomfort during scalp cooling for chemotherapy-induced alopecia prevention: a randomized study.

Chemotherapy-induced alopecia (CIA) is a challenge in the management of cancer patients. Scalp cooling (SC) leads to reduction in CIA, however it is associated with significant adverse events, leading to 3-13% discontinuation rates. This pilot study evaluated the role of Electric Hand Warmers (EHW) on thermal (TC), sensorial (SCo) and general comfort (GC) in patients with breast cancer (BC) undergoing chemotherapy and SC to reduce CIA. Patients were randomly assigned to EHW use or observation. TC, SCo and GC were evaluated after each chemotherapy infusion. Favorable outcomes in both TC and SCo defined a positive result on GC. We analysed the impact of age, alopecia, chemotherapy regimen and EHW use in the different comfort scales using a Logistic Regression (LR) model. Forty women with early breast cancer were randomly assigned to EHW (n = 20) or observation (n = 20) during neo(adjuvant) chemotherapy. Median age was 53 years. In the EHW arm, favorable thermal response was reported by 79% versus 50% in the control arm (odds ratio [OR] 3.79, p < 0.001). SCo was satisfactory in 82% in the EHW arm versus 74% in the control arm (OR 1.62, p = 0.1). Overall, 73% in the EHW arm had favorable GC versus 44% in the control arm (OR 3.4, p < 0.001). Age, alopecia, and chemotherapy regimen did not impact on comfort measures. Conclusion: Our study suggests that the use of an EHW has a consistent favorable impact on TC and GC of BC patients under SC technology to prevent CIA.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Patient's safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study.

BACKGROUND: There is a tendency of prompted global health systems to reduce the length of hospital stay without compromising patient safety or satisfaction. We evaluated the safety and viability of early discharge in patients undergoing minimally invasive radical prostatectomy (MIRP), as well as patient satisfaction with this strategy. METHODS: This longitudinal prospective study included 72 patients who underwent MIRP for prostate cancer. Three groups were performed according to the day of hospital discharge following surgery: same day (G1), first day after (G2), and second day after (G3). Satisfaction, adverse events, and readmission were analyzed for each group. Associations between clinicopathologic variables and same-day discharge were analyzed by comparing data between G1 patients who did and did not achieve same-day discharge. RESULTS: 16.7% of patients were not discharged according to randomization (10 randomized to G1). 80% of G1 patients who did not achieve same-day discharge had Gleason scores of 3 + 4 or 4 + 3, which were observed in 35.7% of patients discharged on the same day (P < 0.05). Average prostate weight was significantly lower in patients who achieved same-day discharge than in those who did not (P < 0.01). Univariable logistic regression points to Gleason scores of 3 + 4 or 4 + 3 as the main factors associated with unsuccessful same-day discharge (P < 0.05). There were no significant differences in satisfaction scores. CONCLUSIONS: Same-day discharge was both safe and feasible and does not appear to affect satisfaction in a subset of patients with prostate cancer. Surgeons should consider the Gleason score when determining whether same-day discharge is appropriate.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer.

OBJECTIVE: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus.

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review.

Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

Análise da densidade endotelial por faixa etária dos doadores de córnea em um banco de olhos no Estado do Paraná, Brasil / Endothelial density analysis by age group of corneal donors in an eye bank in Paraná State, Brazil

Resumo Objetivo: Analisar a densidade endotelial das córneas doadas para transplante nas diferentes faixas etárias. Métodos: O estudo avaliou 244 córneas de 122 doadores de ambos os sexos no Banco de Olhos de Cascavel-PR a partir da análise de prontuários médicos contendo a microscopia especular dos doadores. Resultados: A maioria dos doadores de córnea era do sexo masculino (67,2%). A idade média dos doadores foi 53,8 anos com variações entre 5 e 70 anos. A faixa etária dos 61-70 anos com o maior número de doações, correspondendo a quase 41% e a densidade média endotelial foi de 2645 células/mm² (variando de 1897 a 4201 células/mm²). Na primeira década de vida, a densidade endotelial média foi 2923 células/mm²; na segunda década 2757 células/mm²; na terceira 2846 células/mm²; na quarta 2627 células/mm²; na quinta década, 2830 células/mm²; na sexta 2605 células/mm² e na sétima década de vida 2570 células/mm². Conclusão: Este estudo demonstrou que a densidade endotelial média das córneas doadas para transplante na primeira década de vida (2923 células/mm²) quando comparada isoladamente à sétima década (2570 células/mm²) teve redução. Já na avaliação da segunda até a sexta década não houve um padrão, ora havendo acréscimo, ora decréscimo da densidade endotelial média.

Abstract Objective: To analyze the endothelial density of corneas donated for transplant in different age groups. Methods: The study evaluated 244 corneas from 122 male and female donors in Cascavel Eye Bank -PR from the analysis of medical records containing specular microscopy of the donors. Results: Most corneal donors were male (67.2%). The average donors age was 53.8 years, ranging from 5 to 70 years. The age group of 61 -70 years with the largest number of donations, corresponding to almost 41% and the average endothelial density was 2645 cells / mm² (ranging from 1897 to 4201 cells / mm²). In the first decade of life, mean endothelial density was 2923 cells mm²; in the second decade 2757 cells / mm²; in the third 2846 cells / mm²; in the fourth 2627 cells / mm²; in the fifth decade, 2830 cells / mm²; on the sixth 2605 cells / mm² and on the seventh decade of life 2570 cells / mm². Conclusion: This study demonstrated that the mean endothelial density of corneas donated for transplant of the first decade of life (2923 cells / mm²) when compared to the seventh decade alone (2570 cells / mm²) was reduced. In the evaluation from the second to the sixth decade, there was no pattern, sometimes there was an increase, sometimes a decrease in the average endothelial density.

Treatment With Treprostinil and Metformin Normalizes Hyperglycemia and Improves Cardiac Function in Pulmonary Hypertension Associated With Heart Failure With Preserved Ejection Fraction.

OBJECTIVE: Pulmonary hypertension (PH) due to left heart disease (group 2), especially in the setting of heart failure with preserved ejection fraction (HFpEF), is the most common cause of PH worldwide; however, at present, there is no proven effective therapy available for its treatment. PH-HFpEF is associated with insulin resistance and features of metabolic syndrome. The stable prostacyclin analog, treprostinil, is an effective and widely used Food and Drug Administration-approved drug for the treatment of pulmonary arterial hypertension. While the effect of treprostinil on metabolic syndrome is unknown, a recent study suggests that the prostacyclin analog beraprost can improve glucose intolerance and insulin sensitivity. We sought to evaluate the effectiveness of treprostinil in the treatment of metabolic syndrome-associated PH-HFpEF. Approach and Results: Treprostinil treatment was given to mice with mild metabolic syndrome-associated PH-HFpEF induced by high-fat diet and to SU5416/obese ZSF1 rats, a model created by the treatment of rats with a more profound metabolic syndrome due to double leptin receptor defect (obese ZSF1) with a vascular endothelial growth factor receptor blocker SU5416. In high-fat diet-exposed mice, chronic treatment with treprostinil reduced hyperglycemia and pulmonary hypertension. In SU5416/Obese ZSF1 rats, treprostinil improved hyperglycemia with similar efficacy to that of metformin (a first-line drug for type 2 diabetes mellitus); the glucose-lowering effect of treprostinil was further potentiated by the combined treatment with metformin. Early treatment with treprostinil in SU5416/Obese ZSF1 rats lowered pulmonary pressures, and a late treatment with treprostinil together with metformin improved pulmonary artery acceleration time to ejection time ratio and tricuspid annular plane systolic excursion with AMPK (AMP-activated protein kinase) activation in skeletal muscle and the right ventricle. CONCLUSIONS: Our data suggest a potential use of treprostinil as an early treatment for mild metabolic syndrome-associated PH-HFpEF and that combined treatment with treprostinil and metformin may improve hyperglycemia and cardiac function in a more severe disease.

VERION® - A influência da tecnologia do sistema guiado por imagem expressa no controle pós-operatório de astigmatismo / VERION® - The influence of expressed image-guided system technology on postoperative astigmatism control

Resumo Objetivo: Avaliar o astigmatismo induzido pela cirurgia de catarata através da técnica de facoemulsificação (FACO) guiada pelo planejador cirúrgico VERION®, em um serviço oftalmológico do Paraná. Métodos: O estudo tem caráter observacional com avaliação individualizada de prontuários de forma retrospectiva, analisando 37 olhos de 20 pacientes operados de catarata pela técnica de FACO com a utilização do VERION® e implantação de lente não-tórica no Hospital de Olhos de Cascavel - PR no período de maio de 2016 a novembro de 2018. Resultados: Dentro de nossa amostra composta por 37 olhos abordados com assistência do VERION®, 43% dos participantes do estudo (n=16) apresentaram redução do astigmatismo inicial, inclusive com eliminação de graus mais graves de astigmatismo (≥2.5 D). Conclusão: O impacto do VERION® foi significativo uma vez que permitiu a correção do astigmatismo prévio de uma parte da amostragem. Em olhos que ocorreram astigmatismo induzido cirurgicamente essa complicação foi menos relevante clinicamente em comparação com incisões corneanas da técnica convencional.

Abstract Objective: To evaluate the astigmatism induced by cataract surgery through the phacoemulsification (PHACO) technique guided by the VERION® surgical planner, in an ophthalmological service of Paraná. Methods: This is an observational study with retrospective individualized evaluation of medical records, analyzing 37 eyes of 20 patients who underwent cataract surgery using the PHACO technique using VERION® and non-toric intraocular lens implantation at the Hospital de Olhos de Cascavel - PR in May 2016. Results: Within our sample of 37 eyes approached with VERION® assistance, 43% of study participants (n=16) had reduced initial astigmatism, including elimination of more severe degrees of astigmatism (≥2.5 D). Conclusion: The impact of VERION® was significant as it allowed the correction of previous astigmatism of a part of the sample. In eyes that had surgically induced astigmatism, this complication was less clinically relevant compared to conventional technique corneal incisions.

Síndrome de Wolfram - Diagnóstico clínico de condição rara multissistêmica / Wolfram syndrome - Clinical diagnosis of rare multisystemic condition

Resumo A Síndrome de Wolfram consiste em uma patologia neurodegenerativa de caráter genético, também conhecida pela sigla DIDMOAD que traduz os principais achados dessa doença, Diabetes Insipidus, Diabetes Mellitus, Atrofia Óptica e Surdez. O artigo visa relatar ocaso de um paciente diagnosticado clinicamente com essa síndrome em um ambulatório geral de oftalmologia. Tendo em vistaque os pacientes portadores dessa alteração genética apresentam mais de um par craniano afetado e quadro clínico sem históricode meningite ou outras alterações neurológicas, tem-se que pensar em alterações raras, como é o caso dessa síndrome. A partir dodiagnóstico, aplicou-se o questionário WRUS em consulta, o qual permitiu a comparação do paciente abordado com dados obtidosinternacionalmente disponíveis na literatura.

Abstract Wolfram Syndrome consists of a neurodegenerative pathology of genetic character, also known by the acronym DIDMOAD that translates the main findings of this disease, Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness. The article report the case of a patient diagnosed clinically with this syndrome in a general ophthalmology out patient clinic. Considering that patients with this genetic alteration have more than one cranial nerve affected by the disease and clinical history without meningitis or other neurological alterations, one has to think about rare alterations, as is the case with this syndrome. From the diagnosis, the WRUS questionnaire was applied in consultation, which all owed the comparation of the patient with concepts obtained internationally available in the literature.

Knapsack sprayers: effort required for pumping lever operation / Pulverizadores costais: esforço para o acionamento da alavanca de bombeamento

Various equipment, mainly manual knapsack sprayers, are used to apply agrochemicals by smallholder farmers. They are highlighted by their versatility of use and mainly by their low cost for farmers. Few operator-related studies were reported in the literature regarding the effort required to operate the knapsack sprayer lever. Knapsack sprayers were evaluated regarding the effort required to move their hand levers, reach and maintain the 300 kPa pressure, and return to the initial position. The objective of this study was to evaluate the operators effort to operate the hand lever using the "Super magro" biofertilizer as fluid. It was concluded that all knapsack sprayers are within the Consolidation of Labor Laws (CLT) standards regarding the effort required to operate the hand lever. However, restrictions have been reported in some manual knapsack sprayers regarding international standards.(AU)

Existem diversos equipamentos utilizados na aplicação de agrotóxicos em propriedades familiares, principalmente os pulverizadores costais manuais. Estes ganham destaque pela sua versatilidade de uso e, principalmente, o baixo custo para o produtor rural. Na bibliografia foi constatado poucos estudos relacionados ao operador, quando analisado o seu esforço ao acionar a alavanca do pulverizador costal. Os pulverizadores costais foram avaliados quanto aos esforços necessários ao deslocamento da alavanca: para atingir a pressão de 300 kPa, na manutenção desta e em seu retorno para a posição inicial. Este estudo teve como objetivo avaliar os esforços do operador ao acionar a alavanca utilizando como fluido o biofertilizante composto Super Magro. Conclui-se, no que tange ao esforço para acionamento da alavanca, que todos os pulverizadores estão dentro das normas da CLT (Consolidação das Leis Trabalhistas), porém existem restrições a alguns pulverizadores costais manuais em relação às normas internacionais.(AU)

External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes.

INTRODUCTION: Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. MATERIALS AND METHODS: We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-oneout, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. RESULTS: We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. CONCLUSIONS: In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

Knapsack sprayers: effort required for pumping lever operation / Pulverizadores costais: esforço para o acionamento da alavanca de bombeamento

ABSTRACT: Various equipment, mainly manual knapsack sprayers, are used to apply agrochemicals by smallholder farmers. They are highlighted by their versatility of use and mainly by their low cost for farmers. Few operator-related studies were reported in the literature regarding the effort required to operate the knapsack sprayer lever. Knapsack sprayers were evaluated regarding the effort required to move their hand levers, reach and maintain the 300 kPa pressure, and return to the initial position. The objective of this study was to evaluate the operator's effort to operate the hand lever using the "Super magro" biofertilizer as fluid. It was concluded that all knapsack sprayers are within the Consolidation of Labor Laws (CLT) standards regarding the effort required to operate the hand lever. However, restrictions have been reported in some manual knapsack sprayers regarding international standards.

RESUMO: Existem diversos equipamentos utilizados na aplicação de agrotóxicos em propriedades familiares, principalmente os pulverizadores costais manuais. Estes ganham destaque pela sua versatilidade de uso e, principalmente, o baixo custo para o produtor rural. Na bibliografia foi constatado poucos estudos relacionados ao operador, quando analisado o seu esforço ao acionar a alavanca do pulverizador costal. Os pulverizadores costais foram avaliados quanto aos esforços necessários ao deslocamento da alavanca: para atingir a pressão de 300 kPa, na manutenção desta e em seu retorno para a posição inicial. Este estudo teve como objetivo avaliar os esforços do operador ao acionar a alavanca utilizando como fluido o biofertilizante composto Super Magro. Conclui-se, no que tange ao esforço para acionamento da alavanca, que todos os pulverizadores estão dentro das normas da CLT (Consolidação das Leis Trabalhistas), porém existem restrições a alguns pulverizadores costais manuais em relação às normas internacionais.

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

ABSTRACT Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder.

Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Monitoring structures with optical fibers: infiltration detection.

The use of sensors and optical fibers for monitoring structures is continuously growing. Strains, displacements, accelerations, temperatures are just a few of the monitoring possibilities. In the case of dam structures, concrete face rockfill dams constitute a type of structures where the monitoring of water infiltrations is of particular interest. In large structures of this type, opening of slab joints is a common effect of general strain distributions, but crack formation may also occur as a result of high compressive stresses, during and after the reservoir filling stage. In this context, this paper verifies, experimentally, the applicability and the response of a distributed fiber optic monitoring system in the identification of infiltration spots and its potential sizes. The experimental tests confirm the technical feasibility of detecting infiltrations, but did not show clear evidence of their sizes.